通过高效液相色谱-串联质谱检测诊断口服降糖药引起的人工低血糖症

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Diabetes Mellitus Pub Date : 2024-03-19 DOI:10.14341/dm13119
M. Yukina, E. A. Troshina, N. Nuralieva, V. A. Ioutsi, O. Rebrova, G. A. Mel’nichenko, N. G. Mokrysheva
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引用次数: 0

摘要

背景:人工低血糖(ArH)是指患者在就诊之外故意使用降糖药物,导致血糖水平下降低于 3 毫摩尔/升。及时诊断这种低血糖症可避免不必要的多次检查和住院治疗。然而,对于医疗机构和主治医生来说,检测 ArH 仍然是一项极其困难的任务。国外文献介绍了利用高效液相色谱-串联质谱检测法(HPLC-MS/MS)成功检测出故意摄入口服降糖药(OHD)的案例。因此,开发并验证使用 HPLC-MS/MS 测定 OHD 的方法具有重要意义。目的:优化因使用 OHD 而导致 ArH 的诊断。在一组接受了sOHD治疗的2型糖尿病患者(7人)和一组未接受任何药物治疗的健康人群(7人)中开发了HPLC-MS/MS方法,用于检测血液中研究的OHD(sOHD;n=1-格列本脲,n=1-格列喹酮,n=1-格列齐特,n=1-格列美脲,n=1-格列吡嗪,n=1-纳格列奈和n=1-瑞格列奈)。结果:通过 HPLC-MS/MS 对 2 型糖尿病患者组的血液样本进行研究,100% 的病例都证实了患者服用了药物,而在条件健康者组中则未检测到 sOHD。所有条件健康者和胰岛素瘤患者均未出现假阳性结果。在原因不明的高胰岛素血症 NDH 组的 11 名患者中,有 5 人被诊断为 ArH,该方法在患者的血样中检测出了 sOHD 格列本脲和格列齐特。对该组其余 6 名患者继续进行了检查,并确诊了 NDH 的其他病因。结论:HPLC-MS/MS 方法在检测和鉴定服用 sOHD(格列本脲、格列酮、格列齐特、格列美脲、格列吡嗪、纳格列奈和瑞格列奈)药物的患者血液样本中的 sOHD 时具有很高的诊断准确性。目前,由于该方法的可用性较低,这项研究建议用于一线胰岛素瘤成像方法(计算机断层扫描与造影剂增强、超声波和腹腔磁共振成像)结果呈阴性的高胰岛素血症性低血糖患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnosis of artificial hypoglycemia due to oral hypoglycemic drugs by high-performance liquid chromatography with tandem mass spectrometric detection
BACKGROUND: Artificial hypoglycemia (ArH) is a decrease of blood glucose levels less than 3 mmol/l due to the deliberate use of hypoglycemic drugs by a patient outside of medical appointments. Timely diagnosis of this kind of hypoglycemia avoids unnecessary numerous examinations and hospitalizations. However, the detection of ArH still remains an extremely difficult task for both the healthcare facility and the attending physician. The foreign literature describes cases of successful detection of deliberate intake of oral hypoglycemic drugs (OHD) using high-performance liquid chromatography with tandem mass spectrometric detection (HPLC-MS/MS). Thus, it is relevant to develop and validate a method for determining OHD using HPLC-MS/MS.AIM: To optimize the diagnosis of ArH due to the use of OHD.MATERIALS AND METHODS: A total of 92 patients were examined. The development of the HPLC-MS/MS method for the detection of the studied OHD (sOHD; n=1-glibenclamide, n=1-gliquidone, n=1-gliclazide, n=1-glimepiride, n=1-glipizide, n=1-nateglinide and n=1-repaglinide) in the blood was carried out in a group of patients with diabetes mellitus type 2 (n=7) who received sOHD, and a group of conditionally healthy people who did not receive any medications (n= 7). To validate the method, the determination of sOHD substances was carried out on groups of patients with hyperinsulinemic nondiabetic hypoglycemia (NDH) of unknown origin (n=11) and with insulinoma (n=67).RESULTS: In the study of blood samples by HPLC-MS/MS in the group of patients with diabetes mellitus type 2, was confirmed in 100% of the cases the use of the drug that the patient received, in the group of conditionally healthy — sOHD were not detected. A false positive result was not obtained in any conditionally healthy and in any patient with insulinoma. ArH was diagnosed in 5 out of 11 patients in the group with hyperinsulinemic NDH of unknown origin, the method identified sOHD glibenclamide and gliclazide in the patients’ blood samples. In the remaining 6 patients of this group, examinations were continued and other causes of NDH were diagnosed. The sensitivity of the method was 100% [74%; 100%], specificity — 100% [95%; 100%].CONCLUSION: The HPLC-MS/MS method has high diagnostic accuracy in the detection and identification of sOHD (glibenclamide, gliquidone, gliclazide, glimepiride, glipizide, nateglinide and repaglinide) in blood samples of patients receiving these drugs. Currently, due to the low availability of the method, this study is advisable to use in patients with hyperinsulinemic hypoglycemia with negative results of first-line insulinoma imaging methods (computed tomography with contrast enhancement, ultrasound and magnetic resonance imaging of the abdominal cavity).
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来源期刊
Diabetes Mellitus
Diabetes Mellitus ENDOCRINOLOGY & METABOLISM-
CiteScore
1.90
自引率
40.00%
发文量
61
审稿时长
7 weeks
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